Friday the 13th Tale

My return visit to my orthopedic surgeon today was inauspiciously timed.

He bent my leg, shook it, made sure I realized it wasn't healthy, and rendered his verdict: If I lead an active life, eventually I'm not going to be happy with my knee and I'll come back for surgery. "You're not a potato on the couch," he said. He even said activities like running and sprinting--which don't involve cutting, pivoting or torquing the knee--would lead to knee pain, an assertion that left me, frankly, surprised and dubious.

My verdict: I'm continuing with physical therapy, and I'm going to see a physical medicine and rehab physician--a physiatrist--to see get suggestions on how to stay active without surgery.

No doubt, my body is conspiring against me. I caught a cold a week ago, which restricted my exercise and even PT; I twisted my knee again two weeks ago in an unlucky accident. (My orthopedic surgeon said a torn ACL used to be known as a "trick knee" that "went out" every once in a while. I've heard the term before.)

I take heart from a 2010 New York Times article, cited originally by in the Just A Thought blog, that cited research saying people with ACL tears who had physical therapy alone had improvements after two years comparable to people who had ACL surgery. The PT-only group had knees that were less stable, but that instability didn't seem to be a big deal. The study authors were quoted in the article:

there is no apparent downside of starting a good rehab program and waiting with the surgery decision to see if it is needed or not.

I figure that a physiatrist is much more likely to know what I can do, how much I can do, and how to do it safely with a torn ACL. My appointment is a week from tomorrow; I wish it were tomorrow.

That said, I do feel--and I sweat somewhat saying this in a martial arts blog--for the time being, I must interrupt my mixed martial arts training. I've suffered grievous injury twice to my knees from kicking or being swept in mixed martial arts, and that's a fact that looms very large at the moment.

The thought occurs to me that boxing might be a way of giving myself a similarly intense workout to mixed martial arts, but without kicking or sweeping. It might even offer me a way of continuing to spar, which has challenged and enlivened me in mixed martial arts (though I'd definitely want to talk to the physiatrist about whether and how to do that--e.g., would I need a knee brace?).

I'm facing lots of questions; I don't know where this journey will end up. The next step, when I get up from writing this entry, will be to do another set of physical therapy exercises, and to continue to be patient.

Physical Therapy, Exercise, Careful Training

I'm feeling a bit encouraged about my prospects of continuing to train, with modifications, post ACL tear.

I've been to three physical therapy sessions, and have been good about doing my PT exercises twice daily. Compared to working out, the PT exercises don't feel like they're doing much, but they are clearly doing something to strengthen the muscles around my knee and give me more range of motion (a limitation imposed by the meniscus tear).

I've gone on the elliptical machine at the gym at work three times. I'm using it because there's a limited motion and there's no impact, but I can still get a good cardio workout.

I have also now taken three classes in my mixed martial arts school. I have been very careful about kicks, and my knee has been fine. It's good to see my friends and instructors and to continue to get a workout.

One of those workouts was a private class with our school's Joshu, a young (20s), very skilled martial artist and a friend. We just worked on form for punches and kicks (again, being careful not to do anything that would torque my ACL-less right knee). I had developed a way of throwing round kicks that involved a lot of leaning and turning in order to avoid punches. He worked with me to move my hips independently of my shoulders, which should speed up the kick, allow me to focus more on the target, and I think put me at less risk of torque injuries to my remaining good leg. It will take time to undo prior habits.

I'm not going to spar until I get a knee brace, which I plan to order from my doctor when I see him in three weeks.

My plan continues to be that I will not get ACL reconstruction surgery. I needed ACL reconstruction four years ago to get my black belt. I don't believe I need the ACL reconstruction if I am training for fun and fitness, and if I am very careful.

There's some precedent.

There are, I realized, two women in my school who ruptured their ACLs and who continue to train wearing braces. They're both excellent athletes; they'v had mixed success training in their condition.

One is a second-degree black belt who has been without one of her ACLs for many years. She's one of those amazing Gumby-like types who's about a foot taller than me but can kick me in the head. I haven't seen her on my abbreviated training schedule, but when I do, I will definitely talk with her about how she takes care of her knee. She does some sparring; she doesn't do grappling. Mostly she takes the "core" classes that are bag workouts.

The other fellow student offers a bit of a cautionary tale. She's also a good athlete and is a former cop. However, she did injure her other knee a few months ago--I believe while sparring--and has some discomfort in her daily activities.

That's what I don't want to do.

So for now, it's PT and patience for me.

Facing Uncertainty with Patience

It's going to take patience to work through this ACL tear and figure out what I can and should do.

On Friday morning, I got the diagnosis from my doctor--complete ACL tear in my right knee, plus meniscus damage.

My leg isn't painful except when I bend it too far (meniscus) or I step in a way the knee becomes unstable (ACL). It's more my brain that's sore.

My doctor, who had performed ACL reconstruction surgery on my left knee four years ago, said Friday morning he expected that without an ACL, I could run and eventually probably even sprint--which I'd been doing lately for conditioning. The day before, I had gone on an elliptical machine for 22 minutes, and my leg felt fine at the time. It was a little sore an hour later, which a naproxen took care of. My doctor thought that activity was fine, and said the knee is still healing from the initial incident.

However, while running is okay, he thinks that martial arts would put me at risk of further damage to the knee, which is unstable without an ACL, because martial arts involves torquing the knee. A knee brace wouldn't help with torquing.

I don't want to have ACL reconstruction surgery again. I simply can't afford the time away from work and life it would require right now; in any case, the doctor said the knee needs to heal before surgery, so there's no rush.

The reason my head hurts is that, while I don't want to do ACL surgery, I also do want to continue training.

My martial arts instruction got me into shape; it taught me to face up to my fears; to face up to conflict instead of avoiding it; that getting hit just means I'm still in the fight; that I can protect myself. These are all extremely important things to me, body and soul.

I could maintain my conditioning even if I gave up martial arts. But I would be leaving behind a crucial part of my life if I had to give up my school due to my injury.

I have decided to respond with patience.

I'm going to do physical therapy for a month to strengthen the muscles around the knee to compensate for the lack of an ACL. I'm going to discuss with the therapist, or perhaps even a physiatrist, what activities I can safely do.

I'm going to very carefully try to take certain martial arts classes. On Friday evening, I took a "core" class that entails a bag workout and physical and strength conditioning, but no sparring. I was very careful; my knee was a little sore afterward but fine. Oddly, one of the most difficult things in class was some of the stretching at the beginning.

I'm going to have to leave grappling behind, which I'm fine about.

I would like to carefully, carefully try out sparring, including being selective about partners. I will probably be boxing more than kickboxing--a shame since my kicks were pretty good.

I'll see how my leg does. I'll talk about my situation to doctors and others (including a remarkable classmate who does train without an ACL).

I'll give it time.

"The Amputee's Guide To Sex"

In the past two days of my fresh vacation, I read a book of poems called "The Amputee's Guide To Sex," by the young poet Jillian Weise. In this blog, I wrestle with physical limitations in the martial arts like deepening middle age and ACL surgery. This poet (who is an amputee) is struggling with recurring pain, extreme reactions from other people, self-image issues, you name it. I couldn't read too many of the poems to my wife while she was driving, they were too emotionally raw.

Foreshadowing?

A classmate once observed the tradeoff for not having the ills of a sedentary life--aching back, diabetes-related ills, heart troubles--is having lots of little acute pains.

Today I still have a sore thumb which I jammed a couple of weeks ago, but I also have aches from three days in a row of class, including my first grappling class since August.

And, weirdly, I'm sore from falling out of the shower for the first time in my life. Yesterday, after grappling class, I was taking a shower at home, and I lost my balance; my feet slipped out from under me, and down I want, pulling the shower curtain down with me.

Fortunately I didn't do any serious damage--I didn't hit my head, and my knees bent normally, so no knee injuries. I remember putting a chair in the shower after my ACL surgery to avoid falling and tearing my new ACL.

But I definitely got bruised up. I don't know why I fell, but I quickly thought of how my father, at 89, fell a few months ago and ended up in the hospital. It felt like a foreshadowing of what's to come when I get old, and I didn't like that feeling.

ACL Peace

Merry Christmas! You know your children are growing up when you wake up on Christmas morning before they do.

I started this blog when I was recovering from ACL surgery. I've been very lucky so far (knock on wood) because my ACL has been okay.

Last night, at my wife's family's huge, fun Christmas Eve gathering--we rent a hall, there are so many people--I saw my teenage niece Gina, who one week ago had her second ACL replacement surgery. This time, she got a piece of her quad muscle removed and used as the ACL replacement--I hadn't heard of that procedure much, she said her doctor avows it's stronger than even a patellar tendon ACL. Gina's a real athlete--I think her first ACL surgery was following a basketball injury, and this one was in conditioning camp preparing for lacrosse. Poor baby.

Meanwhile, Black Belt Mama has been having recurring problems with her knee where she had ACL surgery, and they've been interfering with her karate training, and she feels very frustrated.

Unknown at this point for me are the statuses of Hack Shaft, who's had two ACL tears, and Black Belt Blues.

Here are Christmas wishes for healthy ACLs all over the martial blogosphere, and beyond.

And, yeah, peace on earth would be nice, too.

How Nervous Was I?

A fellow student asked me how nervous I was when I tested and finally got my black belt in May. A little background is necessary, because this was my third test.

The first time I tested, I was so nervous that I went to the ATM the day before, and left the cash in the ATM machine. Fortunately the ATM sucked the money back before somebody else came along. However, a Joshu at our school heard about it, and at the test was telling me how he had a free trip to the test because he "went up to the ATM, and some idiot had left $100 in it." He was joking with me because he was trying to get me relaxed. I went to that test with my friend the Hulk, and we both had the classic signs of nervousness--cotton mouth, multiple trips to the bthroom, etc. I passed self defense moves at the test, but didn't get all the way to the kickboxing and grappling.

The next time I tested, in November 2007, I was definitely nervous, but doing much better than the previous time. Although, I think the day before, I went to the ATM, took the money...and left my card in the machine. It also got sucked back in, so nobody drained my bank account.

It was at that November test that my ACL got destroyed, and I had to quit with about three minutes left. The afore-metioned Joshu, who's a real card, was telling me he wasn't surprised I didn't pass, because my wife "told him" that I "never lasted four minutes between the legs with anybody." This time he was trying to cheer me up.

I was enjoying the test up until I got hurt--in particular, I enjoyed the stand-up kickboxing part of the test. I think because I had been to one tournament previously, I was less nervous about it.

When I went for my third time last month, I looked, on the surface, fairly calm, I think. But I was nervous underneath. The day before the test, I showed up to meet someone an hour earlier than I was supposed to and left in confusion.

On the day of the test, my knee was a bit sore, and I didn't really know whether it was because I hurt it a bit training for the test, or whether my knee was "nervous" about returning to the scene of its injury. The hardest part of the test was waiting while the other candidates went through all the parts I had previously passed. I definitely had "fight or flight" syndrome. Once I got on the mat for grappling, it was a relief--and at that point, I started having fun.

I guess the pattern is, the anticipation is terrifying, but the test itself is often fun.

Renewed ACL Woes In The Blogosphere

Life has been very busy lately, and I haven't been keeping up with blogs (mine or others') lately. As I tell people, quoting a favorite old boss of mine, I've been busier than a one-legged man at a butt-kicking contest.

Now, however, I'm on vacation. I kick back, read a few posts--and find that everybody is falling apart.

Hack Shaft, an energetic tae kwan do student, in November (on election night) got a second ACL injury. He's already gone through his operation. He's still got a great attitude, but I can't believe he's going through ACL reconstruction again.

And witty blogger Black Belt Mama is going to have, in effect, her ACL repair repaired in January. She's got a protruding sheath from the prior ACL surgery that needs fixing.

I feel for both of them--I was groaning out loud as I was getting caught up on their blogs. And it's a reminder that, while athletics and martial arts will help preserve our minds, bodies and spirits in the long run, we are running risks in the short run.

Resolution

Turns out Brooke's doctor did evaluate her and decided her growth plate has stopped growing, so she is old enough for traditional ACL surgery (see prior post and the comments on an older post as well). I'm relieved to hear it.

I hope everybody had a fun, relaxing Fourth of July. Just a few less-famous lines from the Declaration of Independence:

...all experience hath shown that mankind are more disposed to suffer, while evils are sufferable, than to right themselves by abolishing the forms to which they are accustomed. But when a long train of abuses and usurpations, pursuing invariably the same object evinces a design to reduce them under absolute despotism, it is their right, it is their duty, to throw off such government, and to provide new guards for their future security.

Teens and ACL Surgery--A Risk

Brooke, a 14-year-old reader who hurt her ACL, has made comments on an earlier post of mine about her fear of ACL surgery.

My concern is that she may be too young for traditional adult ACL surgery. A New York Times article earlier this year talked about the risks. Two passages:

The standard and effective treatment for such an injury in adults is surgery. But the operation poses a greater risk for children and adolescents who have not finished growing because it involves drilling into a growth plate, an area of still-developing tissue at the end of the leg bone.

And here's the scary part for growing teens:

But the standard A.C.L. repair operation, with its drilling into the growth plate, may cause permanent damage to the still-growing bones of young children. After drilling, surgeons replace the torn ligament with a tendon taken from elsewhere in the body, like the hamstring, or from a cadaver. But if the drilling damages a child’s growth plate, the leg bone will not develop normally.

That happened recently to a 14-year-old boy who was referred to Dr. Freddie H. Fu, an orthopedic surgeon at the University of Pittsburgh. A year after the operation, Dr. Fu said, the leg with the repair was bowed 20 degrees on one side and was shorter than the other leg.

“I had to go in on the other side and stop the growth,” Dr. Fu said. “Now, about six months later, the leg is still crooked. There still is a two-inch difference in length which I have to fix.” The boy, he said, “will be a little bit shorter” as a result, although both legs will be the same length.

I'm not a doctor, but I'm encouraging Brooke to show the article to her parents.

For us adult ACL recoverees, we can nod our heads along with this passage from the article (boldface added by me):

Every orthopedist is familiar with A.C.L. tears, but in adults. It is “the most common and most dreaded injury in professional sports,” Dr. Kocher said. The well-established operation to repair it often results in a full return to function. And doctors often recommend that adults have the operation because without the ligament the knee is not stable.

Humility

Paula, among many others, talks about spirituality and martial arts. This may not be the spiritual aspect she means, but certainly martial arts teach humility when you come up against a compatriot who can do something so much better than you.

For me, in grappling, it's my buddy Larry. Larry by his own admission gets nervous at the black belt test, and so hasn't done well on defense moves that are memorized. But he knows so much about grappling--he knows so many moves I've never seen, and remembers more of the ones we've both been taught--that it's a real exercise in humility grappling with him. I can't blame an age or size difference, he's maybe two or three years younger than me, and the same size basically. He even had ACL reconstruction before I did.

Moreover, he does his excellent work with a modest and unassuming attitude, which itself is a commendable spiritual discipline.

Yogi Berra On ACL Recovery

Black Belt Mama, another ACL recoveree, is scheduled to head back to class in two weeks, if she doesn't die first from poison ivy. As with all ACL-reconstructed martial artists, she's nervous about getting back onto the mat.

Michele, who teaches Okinawa Kenpo Karate and Kobudo, has had her own worries about her reconstructed ACL.

I personally think my knee, overall, will never be the same; however, I also think my ACL itself is strong and fairly risk free. But there is doubt in my mind as well.

I've decided that, as with so many things, Yogi Berra (would have) said it best: Getting back on the mat after ACL surgery "is 90% mental -- the other half is physical."

Swamped But Training

Work and home have remained busy, but I did get to three classes this past week (no classes over the Memorial Day weekend). This morning, I did a self-directed physical therapy session for my knee--push-ups (one hand on a ball for some extra work), sit-ups, then lunges with a resistance band, knee leg lifts, etc.

In class, I'm trying to concentrate on grappling, and core class for cardio and strength. While I really love sparring, I don't need that for my black belt, and it's where I re-injured my knee, so I'm taking my time about going back to it.

I put my gym membership on hold. I joined so I could get some cross training during working hours (allowing me more time at home with family), but with my new job I just can't get to the gym.

Hack Shaft is just about to return to his American Karate class after ACL surgery and rehab--we're all looking forward to his report of his return.

I spent a lot of time painting--nothing pink, only blue.

Later this week we're having a home alarm system involved. One of the things preoccupying me after our trip to Philadelphia is we did have a break-in by a confused and troubled person, so we're installing an alarm.

Happy Memorial Day, everybody.

Perspective

My wife, daughter and I will be taking a mini vacation starting today, traveling to Philadelphia to see Ansel Adams photos (Clearing Winter Storm, Yosemite National Park above) and Frida Kahlo paintings at the Philadelphia Museum, run up the steps of the museum and hold up our hands like Rocky, and do other things tourists do in Philadelphia. So no martial arts class this weekend.

I went to two "core" classes in the past two days. One day I parked in front of a nearby Lucille Roberts gym. As I was getting out of the car, a young woman came out of the gym on crutches. I wondered, of course, if she was yet another ACL recoveree.

She was missing a lot more than her ACL, it turns out. She was missing her entire right leg.

I felt so impressed that she was going to the gym--she looked like she was in good shape--and seeing her helped me put into perspective an ACL operation a year ago and a bone bruise a few weeks back.

Waiting for an MRI

I saw an orthopedic doc today. The good news is the leg is still stable, meaning the ACL held up.

The bad news, he said, is that I can't straighten my leg out flat--fully extend it, so that if I were sitting on the floor, I would be pressing the back of the knee against the floor.

I told him the reason I can't straighten out my leg is because it hurts! But he's worried something might have gotten knocked loose and be interfering with the mechanics. That would NOT be a good thing, even if it's far less extreme than an ACL injury.

I'm thinking it may just be the fluid and swelling from the injury that is keeping me from fully extending my leg.

I'll get an MRI Monday night, and a few days later I'll get see this doctor again.

My wife said to me this morning that she's concerned about "this pursuit of health that leads to injuries."

In my mind was the Bob Dylan line, "You're gonna make me give myself a good talking to." I need to find out how serious this injury is. But it does make me think about changes like declining to spar with teens who are nimble enough to kick me in the head. And it also makes me wonder about taking up fitness boxing, where you don't have as much impact, twisting and other stress on the legs.

Ayayay.

Meanwhile, my old Cryo-cuff, from my ACL operation, is on, backwards, cooling off the back of my knee.

I'll just have to wait for a week to see what the doctor says, and then consider what to do next. I hope it's not serious.

Back From Hawaii

Our trip to Hawaii was great--very restorative, a real chance for my wife and me to reconnect.

The photo above is taken at a black-sand beach on the big island of Hawaii. I'm eyeing one of the big green (endangered) sea turtles resting on the beach there. (They don't look green in the air; for some reason, they look green underwater!)

I've added a link to yet another martial artist who's undergone ACL surgery, and in my absence I've gotten comments from others who have undergone or are undergoing the surgery. I know we've got a self-selecting group here, but it does feel like ACL damage is epidemic in the martial arts!

Knee Pain

ACL recoverees, you might not want to read this post just yet.

I'm finally starting to say to friends, "My knee will never be the same."

Thank goodness I had ACL surgery. My knee is stable now, and it wasn't before. I'm not collapsing in a heap when I put my weight on my leg, as I was before the surgery. It was worth the pain of ACL surgery and the long recovery to be able to rejoin martial arts, to not worry about things like dashing down the street or walking on a wet floor.

But I do have continued low-grade pain in my knee at times. I feel my knee in a way I never did before when I do something as simple as walking down the stairs. Just doing drills Wednesday night in martial arts class, blocking very mild low kicks with my shin, made it hurt more.

In February, I return to kicking and being kicked during sparring, and to grappling (how I tore my ACL in the first place). I wonder how those activities will feel. I'm going to take it really easy, and ask my classmates to do the same--I'm going to try to team up with Larry, who also went through ACL surgery.

I'm nervous about it.

One step at a time.

Wednesday night, my entire goal was not to re-injure my knee. On Saturday, my wife and I fly to Hawaii for our delayed 25th anniversary trip--delayed, that is, by my ACL surgery and recovery in the spring. I succeeded in my goal.

We're going to the Big Island, and one of the things we want to visit is a very rare green beach (see photo), which is, I think, due to a volcanic rock called olivine.

This is the perfect time to be going to Hawaii. I can't wait.

Juno and Family; Work and Martial Arts

We're shorthanded at work, and I've agreed to help with some editing and supervision of another six reporters while the right person for that job is found. Like adding another child to a family, my additional charges have generated jealousy among some of my existing reporters. I felt that it wouldn't be good to say no to the (temporary) responsibilities. It will be good to be learning about other parts of my (still new-ish) organization, but I am going to be hammered for time--and one of the reasons I took this job was that the time demands were discrete, not endless. I worry a bit that my time for martial arts will suffer, but I will do my best--I was able to put aside time in my prior job, so I should still be able to do it.

My wife, daughter and I saw the movie Juno Friday night (see photo). Juno, a girl with a spunky attitude and an amazing scriptwriter, gets pregnant in high school. Since we formed our family be adoption, the plights of a quirky but good, unmarried 16-year-old girl and a family trying to adopt made it an especially sweet and moving film for us, while also being very funny.

This week, I went to core class Thursday and Saturday, and we had a quick meeting of the Jersey City Fight Club Friday. I'm hoping to make it to the gym today. It's turning out that Monday is typically my day off now.

In two weeks, I'll be in Hawaii with my wife on the 25th anniversary trip that got delayed by my ACL surgery. I can't wait.

Hack Shaft Beats ACL; Pavlik Beats Taylor

Good news on several fronts tonight.

Paul ("Hack Shaft") is making a terrific recovering from ACL so far, it appears. He even watched his operation. Tough dude.

Meanwhile, Black Belt Mama is continuing her strong recovery from ACL surgery.

I did 26 minutes on the elliptical machine today (why 26? I was too bored for 30 minutes) and am skipping my core martial arts class tonight, to rest my arms from the private trainer's hellacious workout yesterday. I'll take a core class tomorrow.

Meanwhile, tonight at 8 PM (EST) I'm watching on HBO the tape of the Taylor-Pavlik boxing match (see image above, as Pavlik won). Pavlik took Taylor's middleweight title. It was reportedly one heck of a match--Pavlik almost got knocked out in an early round, but returned full force to knock out Taylor in the end. But I had declined to pay extra for PPV to see it. I'm glad I can see it tonight--if I can wrest control of a TV from family members.

Why should martial artists be interested in boxing, despite its many scandals, risk of injuring participants, etc.? My argument: 1) it's a martial art; 2) it requires discipline, courage and timing, just like any other martial art; 3) it requires real tactical insight and clear thinking because, unlike, say, MMA, it lasts round after round, and boxers have to adjust their game.

The Winter Of ACL Discontent

Although the most pain from an ACL operation occurs in the first few days, I found that my lowest point emotionally came several weeks into recovery.

The analogy I would use is the children of our friend Lisa. A number of years back, when they were very small, they looked forward to the holidays (Hannukah in their case). When New Year's Day rolled around, with snow and ice everywhere, they turned to their mother in perplexity: The holidays are over, where's the springtime?

When I was first recovering from ACL reconstruction surgery, my mental attitude, to the extent I could think through the pain, was the equivalent of uttering some choice Anglo-Saxon words and vowing, "I am NEVER going to do this again!"

But pretty quickly I could see progress, which was so encouraging. The pain didn't end right away, but it decreased, and I could do things with my leg like raise it or make visible quad muscles tighten. I enjoyed going to PT and getting good feedback on my progress. One PT intern told me she would always remember me because I was her first patient who was zipping through ACL recovery.

But then I hit a point three or four weeks after the operation when I was ready, like my friend's kids, for springtime: I wanted things to be back to normal. I had been working so hard, and hurting so much, for weeks, wasn't it time for me to be able to do normal things normally again?

It was at that point when I realized that, yes, as I had read, ACL recovery does take a very long time, and even though I had worked really hard, I had a long time and lots of work left to do. My ACL winter would last a long time, and then it would be spring.